不同年龄微创耳蜗植入术麻醉管理的研究  

Anesthetic Management for Minimally Invasive Cochlear Implantation:Study on Different Ages

作　　者：赵艳[1] 蒋建渝[1] 孟秀丽[1] 韩彬[1] 俞晨[1] 郭向阳[1] 

机构地区：[1]北京大学第三医院麻醉科,北京100191

出　　处：《中国微创外科杂志》2010年第12期1114-1117,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨不同年龄患者微创耳蜗植入术的麻醉管理要求。方法回顾性分析2002年3月～2010年4月27例重度～极重度听力丧失,在全身麻醉下进行微创耳蜗植入术的临床资料。根据患者的年龄分为2组:A组(年龄<6岁,n=13),B组(年龄>6岁,n=14)。分析2组麻醉过程中心血管参数的变化、手术时间、术中出血量、输液量、拔除气管导管的时间、满足术中特殊需求的麻醉技术(控制性降压、面神经监测和未留置尿管)以及并发症的情况。结果所有患者麻醉诱导和维持过程中心血管指标稳定。因年龄不同,2组间平均动脉压和心率比较差异有统计学意义;2组术中60、120min和术毕的平均动脉压和心率与麻醉前比较差异有统计学意义(P<0.05),但是变化均在正常生理范围内,这种差异无临床意义。A组手术时间(174±36)min与B组(175±33)min无统计学差异(t=-0.075,P=0.941)。A组输液量(475±292)ml显著少于B组(927±535)ml(t=-2.694,P=0.012)。A、B组拔管时间分别为(7.2±3.3)min和(6.6±3.5)min,无统计学差异(t=0.457,P=0.651)。22例面神经监测,即使限制应用肌肉松弛药也能维持适当的麻醉。未留置尿管的患儿未发现膀胱鼓胀。无麻醉并发症。结论除了通常的麻醉管理之外,在适宜的患者(年龄>6岁)采用适度的控制性降压、限制肌肉松弛药(采用面神经监测的任何年龄患者)和尿管的使用(小于15岁的患者不留置尿管)是关键。Objective To investigate the requirements of anesthetic management for minimally invasive cochlear implantation in patients with different ages.Methods A retrospective review was conducted on clinical data of twenty-seven patients who were diagnosed with severe to profound hearing loss,undergoing minimally invasive cochlear implantation under general anesthesia from March 2002 to April 2010.The patients were divided into two age groups：Group A（aged 6 years,n=13）and Group B（aged 6 years,n=14）.General data,etiology of hearing loss,cardiovascular changes during anesthesia,duration of surgery,blood loss,fluid volume,time to extubation,anesthetic techniques meeting intraoperative special requirements（controlled hypotension,facial nerve monitoring and without urine catheter）and complications were analyzed.Results All the patients had stable cardiovascular variables during induction and maintenance of anesthesia.Though significant differences were detected statistically in the mean arterial pressure（MAP）and heart rate（HR）between the two groups,due to the different ages;comparing with the values before anesthesia,significant differences were calculated statistically in the MAP and HR at the time of 60 min,120 min during operation,and at the end of surgery in the two groups,the changes were with in the physiologically normal limit,the differences had no clinical significance.No significant differences were found in the duration of surgery between the groups A（174±36 min）and B（175±33 min,t=-0.075,P=0.941）.The fluid volume in the group A [（475 ± 292）ml] was significantly less than that in the group B [（927 ± 535）ml,t=-2.694,P=0.012].Time to extubation was（7.2 ± 3.3）min in the group A and（6.6 ± 3.5）min in the group B respectively,no significant differences were detected between the two groups（t=0.457,P=0.651）.Anesthesia was maintained adequately even though muscle relaxants were restricted in the 22 patients with the facial nerve monitoring.No inflated urinary bladder w

关 键 词：耳蜗植入术 麻醉 监护 

分 类 号：R614[医药卫生—麻醉学]